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Assessment of the impact of measurable behaviors on glycemic control using continuous subcutaneous insulin infusion

Mary White, Michele A O Connell & Fergus J Cameron

Aim: To explore continuous subcutaneous insulin infusion (CSII) behaviors in a pediatric population with Type 1 diabetes mellitus, and their association with glycemic control. Research design & methods: Youth were defined as ‘within target’ (HbA1c≤7.5%/58.5 mmol/mol) and ‘above target’ (HbA1c >7.5%/58.5 mmol/mol), 12–18 months post‑CSII. The above-target group was subdivided into: ‘adherent yet above target’ (at least four blood glucose levels and at least six bolus wizard events entered per day) and ‘nonadherent’ (fewer than four blood glucose levels or fewer than six bolus wizard events entered per day). Results: Out of 60 patients, 51.5% (31 out of 60) were within target. Adherent yet above target youth demonstrated similar CSII behaviors to the within-target group, yet their glycemic trajectory mimicked that of their nonadherent peers. Conclusion: CSII requires users to be target driven and proactive in adjusting settings to achieve glycemic control. A ‘passive’ attitude towards CSII is potentially as detrimental to glycemic control as frank nonadherence to recommended behaviors.